As far back as 1950, doctors had for some time been engaged with the remote observing of their patients. Neurological and psychiatric consultations were pioneers in the utilization of electronic innovation. Telemedicine was significantly done utilizing landlines and closed-circuit TVs. Be that as it may, the mammoth wave of improved technology in the form of internet and mobile devices carried with it an expanding telehealth world.
Telemedicine is the art of utilizing telecommunication technology to remotely deliver healthcare services. It has appeared to improve access to health care services particularly for rural communities, promote early detection of diseases, increase patient compliance and overall satisfaction.
The United States Department of Veterans Health Affairs was one of the first organizations to deploy a large-scale tele-retinal imaging program beginning in 1999. In 2006, this program was extended and received further financing for an across the country program. As per AAO, "the rapid improvement of electronic imaging capacity and biometric data acquisition in ophthalmology, combined with equal advancements in health information technology and widely available broadband connectivity, has created new pathways for delivery of eye care services. These pathways improve access by broadening the reach of medical eye care services, improve clinical outcomes by providing care in a timely fashion, and enhance patient satisfaction by providing care in a setting and at a time convenient for the patient.”
As of late, the utilization of telemedicine has become progressively mainstream. More patients prominently from the older populace and rural regions choose tele-visits over in-patient visits. Telemedicine benefits patients by giving them the chance to receive care from the solace of their homes. As telemedicine is quickly turning into an essential instrument in the American health care framework, its essential objective is to improve general eye wellbeing by decreasing the issue of vision-threatening diseases globally.
Notwithstanding its advantages, telemedicine has been known to have its own impediments. Some of which include: the issue of repayment from insurance agencies, significant expense of ophthalmic imaging devices and the limitation to see patients across states because of individual state licensure.
In any case, the covid-19 emergency laws have given rules to improve health services and diminish exposure risk. To address the urgent public health concerns, the FDA issued a policy to help extend the scope of remote ophthalmic evaluation and monitoring devices to facilitate patient care from home. These policies apply to devices that assess ophthalmic parameters. Devices utilized in telemedicine (eye health) rely on a standard for the representation, storage, and transmission of medical images known as Digital Imaging and Communications in Medicine (DICOM). Thus, ophthalmic monitoring devices should have the potential to be connected to a wireless network through Bluetooth, Wi-Fi, or cellular connection to transmit a patient’s ophthalmic parameters directly to their eye care provider or other monitoring entity. Some of these devices also have the potential to apply algorithms to transform a patient’s ophthalmic parameters into a novel index or alarm that may aid an eye care provider in the diagnosis of a particular disease or be used in the context of a telemedicine visit, with the patient at home, allowing the eye care provider to assess specific ophthalmic parameters remotely.
As most devices are designed for use in a clinical setting or health facility, the FDA distributed some direction in the alteration of these ophthalmic devices. These adjustments include: changes to device indications and functionality from use in a clinical setting to use in a home setting; user-friendliness of devices; variation of non-portable devices to incorporate portable or handheld device features; amendments to the devices, including changes in hardware or software, to include virtual reality or mobile technology for telemedicine consultations. The FDA's goal of this strategy is to promote the continued availability of safe and effective medical devices for remote assessment and monitoring of ophthalmic parameters in response to the COVID-19 public health emergency. Examples of these devices include visual acuity charts, visual fields charts, ophthalmic imaging devices and so on.
Medical insurances also modified some policies to encourage more physician participation. In March 2020, the Centers for Medicare and Medicaid Services (CMS) gave strategies that permit healthcare providers to do what needs to be done, and to pay them for it. These include:
Adaptability on the earlier restriction on inter-state between state boundaries: Medicare will currently pay for office, emergency clinic, and different visits done through telehealth across the nation and including a patient's residence. A range of health care providers, for example, physicians, nurse practitioners, clinical psychologists, and licensed clinical social workers will have the option to offer telehealth to their patients.
Reimbursements: Medicare has chosen to pay doctors the standard office rate (POS) payment for services provided through telehealth, and not apply the site-of-service differential related to in-patient type encounters.
Confidentiality: HIPAA and Privacy Standards have been temporarily relaxed to permit the use of Facetime, Zoom, Skype and certain real-time two-way telecommunications with patients for office visits.
Documentation: the strict requirements regarding documentation of patient telemedicine visit have also been relaxed.
Telemedicine is the future and the arrival of portable ophthalmic devices to improve this remote means of eye care reinforces this. Telemedicine does not mean you will not go in-patient to see your doctor. While it may help reduce patient wait time, it also increases accessibility to care. Get to know the telemedicine services your eye care specialist provides and look for ways you may participate in it.
Sources:
Telehealth. What is it, How to prepare, Is it covered?
https://www.nia.nih.gov/health/telehealth-what-it-how-prepare-it-covered
Teleretinal Imaging to Screen for Diabetic Retinopathy in the Veterans Health Administration Cavallerano, A. A., & Conlin, P. R. (2008). Teleretinal imaging to screen for diabetic retinopathy in the Veterans Health Administration. Journal of diabetes science and technology, 2(1), 33–39. https://doi.org/10.1177/193229680800200106
What is Digital Health?
https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health
Telehealth Image
https://wexnermedical.osu.edu/-/media/images/wexnermedical/pages/departments/national-reputation-campaign/stories/ophthalmology/telehealth_ophthalmology.jpg
Image of Retina on Phone
https://www.rsipvision.com/retinal-images-taken-with-mobile-cameras/
Image of Snellen’s Chart on Phone
https://www.cleanpng.com/png-snellen-chart-eye-chart-eye-examination-visual-acu-5663587/